Does It Matter if You Dislike Your Doctor?

Source: Image by Edwintp, pxhere, CCO

Can disliking your doctor be hazardous to your health?

I was surprised to learn recently that liking or disliking your physician can directly affect health outcomes. In a new book, Your Life Depends on It: What You Can Do to Make Better Choices About Your Health, researcher Talya Miron-Shatz argues that the doctor-patient relationship is important for healing, not just “icing on the cake.” Her conclusions are research-based and back up our intuitive feeling that a good relationship with our physician is important for our health, and even a matter of life or death in some cases.

While multiple factors come into play when it comes to patient health, here are five ways that the doctor-patient relationship can affect patient behaviors and health outcomes, according to Miron-Shatz’s summary of the research:

1. Self-disclosure by patients. Patients are more likely to reveal their symptoms to a doctor who lends a sympathetic ear. It’s not just a matter of informing the physician about their current medications, nutrition, and health habits: “Patients must have a certain level of trust in their doctors if they are to confide about multiple sexual partners, substance abuse, embarrassing symptoms, and the like.” Better self-reports by the patient then lead to more appropriate care by the doctor.
2. Accurate diagnosis by doctors. An impersonal doctor is less likely to listen to patients and make a correct diagnosis. Doctors who do not learn about how to elicit patients’ concerns can “mistreat” the patient in both senses of the word. In a study by the Mayo Clinic, only a third of doctors managed to draw out patients’ concerns, and in two-thirds of those encounters, clinicians interrupted patients after only 11 seconds.
3. Better self-care by patients. Doctors who are dismissive or uncaring may indirectly cause patients to neglect their own health. Miron-Shatz explains the psychological underpinnings of that result: "Patients internalize their doctors’ criticism or lack of care, almost like rejected children, and, accordingly, don’t take care of themselves. We need our doctors to care, or to care enough, so we’ll be good enough patients.” And if some patients don’t get the TLC they need, they rebel and are less likely to adhere to a prescribed treatment plan.
4. Ability to comprehend medical information. When patients are under stress, or in actual distress, their ability to understand the information presented by their doctor is greatly reduced. Patients who dislike or distrust their physicians are likely to feel greater stress, be less receptive to new ideas, and be more focused on escaping the situation rather than seeing it as a learning opportunity.
5. Asking questions or clarifying instructions. Patients are more likely to follow through on doctor recommendations if they feel free to ask questions. In fairness to docs, their time with each patient is often restricted by health insurance companies or by Medicare. The standard allotment is usually only 15 minutes per visit. This may not be enough for those with chronic illnesses or for seniors who may have three or more chronic medical conditions.

The Placebo Effect

From a different angle, liking your doctor may also trigger “the placebo effect,” in which we believe that we are about to get better and, because of that belief, we actually do get better to some degree. While we usually think of a placebo as a sugar pill or fake treatment that does nothing to promote healing, a series of studies has shown that placebos can actually cause biological effects, journalist Jo Marchant reports in her book Cure. For example, some researchers have documented that taking a placebo triggers the release of endorphins, our natural painkillers, thus reducing discomfort and pain. (It is important to recognize, however, that this does not mean that placebos can address underlying disease processes or lead to a positive outcome in the long run, as Marchant points out.)

Marchant makes a critical point, paralleling Miron-Shatz, when she asserts that "if we feel safe, cared for and in control—in a critical moment during injury or disease…we do better. We feel less pain, less fatigue, less sickness.” The mind plays a role in health, even though it can’t always be the key to a cure.

Warnings and Perspective

It probably goes without saying that it's not just communication and relationships that are important to good medical care. Purveyors of "snake oil" with a good bedside manner are a danger to any patient. A doctor's competence, the resources available to medical staff, health insurance, and the presence of good support staff all play a role in health outcomes.

Miron-Shatz makes the excellent point that overworked doctors and medical staff run the risk of burnout and that our idealization of our "health heroes" can often put them under even more pressure: “Burned out doctors show less empathy toward patients and are more likely to make medical errors.” Doctors shouldn't just be admired for their resilience; they need resources, time, and support from the organizations they work for. We need to help the healers, just as we need to help those who are ill.

While it may be obvious, it's worth mentioning that patients are not always courteous to their doctors, either. They can be rude, demeaning, and impatient. Feeling ill, being reminded of one's mortality, or feeling vulnerable or embarrassed in a medical situation does not necessarily bring out the best in people, regardless of how caring a physician may be. It may help to read one of the many good articles that tell you how to prepare for your appointment.

In the final analysis, personal responsibility plays a critical part. Everyone needs to take charge of their own health as much as possible by adopting healthy habits, keeping up with new health information, speaking up assertively to their physician about their concerns, and taking the time to get a second opinion when necessary. We need enough self-love to know in our bones that protecting our health and well-being is worth the effort.

(c) Meg Selig, 2021. All rights reserved.